"Medicine is a social science, and politics is nothing else but medicine on a large scale"—Rudolf Virchow

May 21, 2014

Polio: An unwelcome return

Heidi Larson of the London School of Hygiene and Tropical Medicine puts the blame for fuelling the transmission of polio largely on Pakistan. It is the big backslider, accounting for the vast majority of cases (61 out of 77) this year, compared with just eight during the same period in 2013.

In recent years Pakistan has allowed some of its most lawless regions to become havens for the virus. Hardly any of the 290,000 children in the two Waziristans, for example, have been vaccinated since 2012—the year militant chieftains declared a ban on the work of vaccinators, most likely in retaliation for American drone strikes.

The fact that the CIA is said to have used a fake vaccine campaing in the search for Osama Bin Laden has not helped the cause. (In response to a wave of deadly attacks on polio workers in the region, the American government said yesterday that the CIA has ended the use of vaccine programmes in its spying operations.)

In addition, people in the region are exceptionally mobile, with large in- and outflows of jihadists, aid workers and refugees, all acting as possible couriers of the disease. Many of the strands found around the world, including in Israel and Afghanistan, originated in Pakistan.

Beyond the steps proposed by the WHO, more health diplomacy and intelligent security efforts could help curb polio’s spread by facilitating medical activities in conflict zones, says Dr Larson. But she admits that the Pakistani situation is far more complex than the one in northern Nigeria during the region’s polio-vaccination boycott in 2003-04, which Dr Larson helped to end as part of UNICEF’s negotiating team. Internal conflict and tribal loyalties in Pakistan are complicating matters.

It is critical to combat polio quickly, while its resurgence is still small. The downside of the disease becoming so rare—even with the increase in the number of cases this year, the disease’s occurrence has diminished by over 99% since 1988—is that people’s natural resistance has also been reduced.

A failure to eradicate the disease could lead to as many as 200,000 new cases per year within the next decade, warns the Gates Foundation, which spends a lot of money to fight polio. This would put huge strain on medical budgets: a worldwide vaccination campaign, for instance, costs around $1 billion per year. But as Benjamin Neuman, a virologist at the University of Reading, points out, "you need to eradicate wars before you can eradicate polio."

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Heidi Larson of the London School of Hygiene and Tropical Medicine puts the blame for fuelling the transmission of polio largely on Pakistan. It is the big backslider, accounting for the vast majority of cases (61 out of 77) this year, compared with just eight during the same period in 2013.

In recent years Pakistan has allowed some of its most lawless regions to become havens for the virus. Hardly any of the 290,000 children in the two Waziristans, for example, have been vaccinated since 2012—the year militant chieftains declared a ban on the work of vaccinators, most likely in retaliation for American drone strikes.

The fact that the CIA is said to have used a fake vaccine campaing in the search for Osama Bin Laden has not helped the cause. (In response to a wave of deadly attacks on polio workers in the region, the American government said yesterday that the CIA has ended the use of vaccine programmes in its spying operations.)

In addition, people in the region are exceptionally mobile, with large in- and outflows of jihadists, aid workers and refugees, all acting as possible couriers of the disease. Many of the strands found around the world, including in Israel and Afghanistan, originated in Pakistan.

Beyond the steps proposed by the WHO, more health diplomacy and intelligent security efforts could help curb polio’s spread by facilitating medical activities in conflict zones, says Dr Larson. But she admits that the Pakistani situation is far more complex than the one in northern Nigeria during the region’s polio-vaccination boycott in 2003-04, which Dr Larson helped to end as part of UNICEF’s negotiating team. Internal conflict and tribal loyalties in Pakistan are complicating matters.

It is critical to combat polio quickly, while its resurgence is still small. The downside of the disease becoming so rare—even with the increase in the number of cases this year, the disease’s occurrence has diminished by over 99% since 1988—is that people’s natural resistance has also been reduced.

A failure to eradicate the disease could lead to as many as 200,000 new cases per year within the next decade, warns the Gates Foundation, which spends a lot of money to fight polio. This would put huge strain on medical budgets: a worldwide vaccination campaign, for instance, costs around $1 billion per year. But as Benjamin Neuman, a virologist at the University of Reading, points out, "you need to eradicate wars before you can eradicate polio."